A 38-year-old man landed in the emergency room the other day, almost convinced he had suffered a heart attack. He had waves of chest tightness, palpitations and claimed he had a bad headache early morning despite sleeping well. He said he had never experienced these symptoms before. Though we ran an electrocardiogram that ruled out a heart attack, what surprised me was his high blood pressure (BP), 168/110 mmHg. His irregular heart rhythms had stemmed from the heart working harder due to high BP. He told me that he had never felt uneasy or dizzy and had never got himself screened for blood pressure simply because he kept to his gym routine. That, he thought, would offset the effects of a stressful job that demanded long hours. Except it didn’t as hypertension crept up silently. As someone who sees many patients with hypertension every day, I’ve come across a wide spectrum of cases where symptoms were far from the textbook definition. Recognising these lesser-known signs can be life-saving — especially for those who haven't had their blood pressure checked recently. 1. Frequent Nosebleeds While not always indicative of hypertension, frequent or unexplained nosebleeds — especially in the absence of trauma — can sometimes be linked to a sudden spike in blood pressure. If you’re experiencing this symptom regularly, get your BP monitored. 2. Blurred Vision or Eye Changes The eyes are sensitive to changes in BP. Long-standing hypertension can lead to hypertensive retinopathy, which may manifest as blurred vision, visual disturbances, or even sudden loss of sight in severe cases. An eye check-up often reveals these changes before symptoms become severe. 3. Fatigue or Confusion When BP remains high over time, it affects blood flow to the brain. Patients — especially older adults —report feeling tired, confused or unable to focus, which could be early neurological signs of poorly controlled blood pressure. 4. Shortness of Breath If walking short distances or climbing stairs suddenly leaves you breathless, this could be a red flag. Persistent high BP may weaken the heart muscle, eventually leading to heart failure, where shortness of breath becomes a hallmark symptom. 5. Blood in Urine Hypertension can damage the kidneys over time. Microscopic damage to the blood vessels can result in hematuria, or blood in the urine. While this can also occur due to other issues like infections or stones, it is sometimes an indirect indicator of poorly-controlled hypertension. 6. Facial Flushing Sudden flushing or redness in the face may occur during BP spikes, especially in individuals with stress-related or secondary hypertension. 7. Ringing in the Ears (Tinnitus) Persistent or pulsating tinnitus can sometimes be linked to elevated BP, especially when accompanied by headaches or dizziness. It may be the body’s way of signalling changes in blood flow or pressure in the head and neck area. The key issue with hypertension is that it can quietly damage organs over time—especially the heart, brain, kidneys and eyes. Recognizing unusual signs early can prevent complications. All you need is a simple reading. (Dr Chatterjee is internal medicine specialist, Apollo, Delhi)
